Sella Volume and Posterior Fossa Morphometric Measurements in Chiari Type 1.

AIM: To retrospectively evaluate the relationships between morphometric measurements in craniovertebral junction, and the possible genetic basis of the disease in Chiari 1 malformation patients undergoing surgical treatment. MATERIAL AND METHODS: We included patients who underwent surgical treatment for Chiari 1 malformation with unknown etiology between 2013-2018 in the Neuosurgery Clinic of Eskisehir Osmangazi University. Morphometric and volumetric measurements of the posterior fossa from cranial and cervical radiological imagings of patients with Chiari 1 malformation were performed by a single experienced observer. The results were independently reviewed by two experienced observers who supervised the process and verified the calculations. RESULTS: It was observed that basal angle was greater in the group of patients with Chiari 1 malformation (125.29° ± 9.522° Vs. 112.33° ± 9.09°), and a significant difference was observed (p=0.000). In patient group, it was also found that the basion-dens distance (3.51 mm ± 1.695mm Vs. 5.27 ± 1.695 mm) (p=0.000), and cerebellar hemispher height were shorter (58.47 ± 5.143 mm Vs. 52.05 ± 5,008 mm) (p=0.000). Tentorium angle was greater in the patient group (97.95° ± 11.321° vs. 87.79° ± 9.891°) (p=0.034). In patient group, dens height was found to be longer (13.9 ± 2.46 mm vs. 14.79 ± 1.631mm) (p=0.041). Sella volume was found to be smaller (41.4 mm3 Vs. 53.3 mm3) in the patient group compared to the control group (p=0.034), and foramen magnum plane was larger (64.6° vs. 31.1°) (p=0.000). CONCLUSION: It is concluded that many parameters including BA, FMP, BDD, CHH, TA, DH, and cellar volume are abnormal, suggesting the need for focussing to the hormonal metabolism - related synchondral changes.

Adjunctive role of immunohistochemical expression of Nucleostemin in differentiation of grade II and III diffuse astrocytomas.

AIMS: Astrocytomas are common tumors and grade is an important parameter in determining the treatment modalities. Tumor proliferation activity should be determined for the differentiation of grades II and III tumors. In difficult cases, an auxiliary parameter is required. Nucleostemin (NS) is nucleolar Guanosine triphosphate (GTP)-binding protein 3. It has important roles in cell proliferation, cell cycle regulation, self-renewal, and apoptosis. In this study, we investigated whether the level of NS expression is different in grades II and III astrocytomas. SETTINGS AND DESIGN: Adults diagnosed with grades II and III astrocytomas were included in the study. MATERIAL AND METHODS: Paraffin blocks that best reflected tumor morphology were studied via immunohistochemical staining for NS. Only nuclear staining was evaluated; cytoplasmic staining was not considered. STATISTICAL ANALYSIS USED: Fisher's exact test, continuity corrections, and Pearson's Chi-square tests were used in the crosstabs. The survival analysis was based on the Kaplan-Meier method. RESULTS: Only 20% (6/30) of grade II tumors had high intensity staining, while 54,2% (13/24) of grade III tumors had high staining intensity. NS was significantly more intense in grade III tumors than grade II tumors. In cases with high NS expression, survival was significantly shorter than the cases with low expression. CONCLUSION: NS is significantly higher expressed in grade III tumors than grade II tumors. In difficult cases, it can be used as a useful proliferation marker in the differentiation of grades II and III astrocytomas.

Misdiagnosed Case of Scalp Arteriovenous Malformation.

Scalp arteriovenous malformations (AVMs) are abnormal vascular lesions that can be treated safely and effectively, with surgical or endovascular approaches. Because of their complex vascularity, the detailed preoperative evaluation must be carefully performed. Here, we present a case of scalp AVM that required two operations as a result of a misdiagnosis because of inadequate preoperative assessment.

Treatment of cervical subaxial injury in the very young child.

INTRODUCTION: Infant's cervical spine has serious differences compared to other pediatric age groups and adults. Anatomical and biomechanical constitution of an infant is unique, and the pediatric spine gradually begins to resemble the structure of the adult spine after age 10. In addition, clinical presentation of the cervical spinal traumas has many distinctions from birth to the end of adolescence. In young children, cervical spine traumas are mainly localized in the upper cervical region. Trauma localized in subaxial cervical region and fracture-dislocations are rare in infants. CASE REPORT: Here, we present a case history of a 7-month-old infant with surgically treated severe subaxial flexion-distraction injury. Neurologic examination revealed complete loss of motor function below C5. A whole-body CT was taken and we observed that C5-6 dislocated anteriorly approximately one vertebra size and also unilateral facet joint was locked. The patient was intubated and closed reduction was attempted with fluoroscopy under general anesthesia, but it was unsuccessful. Whereupon C5-6 microdiscectomy was performed with the anterior approach and fixation was provided with the craniofacial miniplate. Despite anterior stabilization, exact posterior alignment could not been achieved so, posterior approach was added to the surgery. At 12 month follow-up, the patient improved from quadriparesis to paraparesis and we achieved a satisfactory radiological outcome.

Calvarial-orbital Metastasis of Prostate Carcinoma which was Diagnosed with Sixth Cranial Nerve Palsy.

Sixth nerve palsy is frequently due to infectious orbital lesions, trauma, elevated intracranial pressure, brainstem lesions, and vasculopathies. Here, we describe a rare cause of sixth cranial nerve (CN) palsy secondary to calvarial and orbital metastasis of prostate carcinoma. The diagnosis of the prostate carcinoma with sixth CN palsy is a very rare condition. A 66-year-old male patient presented with complaints of blurred vision, double vision, and inability to move outward in the right eye for 3 weeks. Magnetic resonance imaging revealed a right orbitocalvarial mass and the mass surgically removed completely. Pathologic findings were compatible with prostate adenocarcinoma metastasis. After surgical removal, significant improvement in sixth CN palsy was observed.

Treatment of Unstable Thoracolumbar Fractures: Does Fracture-Level Fixation Accelerate the Bone Healing?

OBJECTIVE: To investigate the effect of fusion on short segment including fractured level (SSIFL) and long segment (LS) transpedicular fixation after acute thoracolumbar junction burst fractures. The 2-year clinical and radiologic follow-up results of the 2 groups also were compared. METHODS: Seventy-four patients were randomized into one of 2 groups: SSIFL (n = 39) or LS (n = 35). The SSIFL group included one level above and one level below, including the fracture level, whereas the LS group included 2 levels above and 2 levels below, excluding the fracture level, for the transpedicular fixation. Fusion was assessed by technetium 99m-methylendiphosphonate, bone scintigraphy, and single-photon emission computed tomography. The 2-year follow-up results were compared clinically (Oswestry Disability Index and visual analog scale) and radiologically (kyphosis angle, sagittal index, anterior vertebral body height loss) at regular intervals. The clinical scores and radiologic parameters of patients with and without fusion also were compared. RESULTS: The number of patients with fusion was significantly greater in the SSIFL group compared with the LS group. There was a significant reduction of the clinical scores of patients who had fusion compared with the fusion-free group; however, there was no radiologically significant difference. Furthermore, there was no significant difference between the SSIFL and LS groups in terms of the 2-year radiologic and clinical follow-up results. CONCLUSIONS: Fusion occurred sooner and patients experienced earlier clinical recovery in the SSIFL group compared with the LS group.

Can a Small Intestine Segment Be an Alternative Biological Conduit for Peripheral Nerve Regeneration?

BACKGROUND: Autologous nerve grafts are used to bridge peripheral nerve defects. Limited sources and donor site morbidity are the major problems with peripheral nerve grafts. Although various types of autologous grafts such as arteries, veins and muscles have been recommended, an ideal conduit has not yet been described. AIMS: To investigate the effectiveness of a small intestinal conduit for peripheral nerve defects. STUDY DESIGN: Animal experimentation. METHODS: Twenty-one rats were divided into three groups (n=7). Following anaesthesia, sciatic nerve exploration was performed in the Sham group. The 10 mm nerve gap was bridged with a 15 mm ileal segment in the small intestinal conduit group and the defect was replaced with orthotopic nerve in autologous nerve graft group. The functional recovery was tested monthly by walking-track analysis and the sciatic functional index. Histological evaluation was performed on the 12th week. RESULTS: Sciatic functional index tests are better in autologous nerve graft group (-55.09±6.35); however, during follow-up, progress in sciatic functional index was demonstrated, along with axonal regeneration and innervation of target muscles in the small intestinal conduit group (-76.36±12.08) (p<0.05). In histologic sections, distinctive sciatic nerve regeneration was examined in the small intestinal conduit group. The expression of S-100 and neurofilament was observed in small intestinal conduit group but was less organised than in the autologous nerve graft group. Although the counted number (7459.79±1833.50 vs. 4226.51±1063.06 mm2), measured diameter [2.19 (2.15-2.88) vs. 1.74 (1.50-2.09) µm] and myelin sheath thickness [1.18 (1.09-1.44) vs. 0.66 (0.40-1.07) µm] of axons is significantly high in the middle sections of autologous nerve graft compared to the small intestinal conduit group, respectively (p<0.05), the peripheral nerve regeneration was also observed in the small intestinal conduit group. CONCLUSION: Small intestinal conduit should not be considered as an alternative to autologous nerve grafts in its current form; however, the results are promising. Even though the results are no better than autologous nerve grafts, with additional procedures, it might be a good alternative due to harvesting abundant sources without donor site morbidity.

Nerve Tissue Prefabrication Inside the Rat Femoral Bone: Does It Work?

AIM: To investigate whether nerve regeneration can be induced in the tubular bone between distal and proximal cut nerve ends. MATERIAL AND METHODS: Twenty adult Wistar rats were used for the study. Rats were divided into three groups; femoral bone conduit group, nerve transection group, sham group. The sciatic nerve was surgically cut and from both ends inserted into the adjacent femoral bone tunnel in the femoral bone conduit group. The sciatic nerve was cut transversely in the nerve transection group. In the Sham group, only sciatic nerve exploration was performed, without a nerve cut. The groups were evaluated functionally and morphologically. RESULTS: All results showed that axonal growth existed through the osseous canal. CONCLUSION: To the best of our knowledge, this is the first study to evaluate neural regeneration inside the bone. We can speculate that the bone marrow provides a convenient microenvironment for peripheral nerve regeneration. In addition to prefabricating peripheral nerves, this novel model may help to establish further strategies for engineering of other tissues in the bone marrow.

Neuroprotective Effect of Genistein in Peripheral Nerve Injury.

AIM: To investigate the effects of genistein in a rat model of sciatic nerve crush injury and complete sciatic nerve transection. The effects of genistein were compared with those of gabapentin, which is widely used in clinical practice for peripheral nerve injury. MATERIAL AND METHODS: Forty-eight rats were randomly divided into six groups (8 rats in each group): group 1 (sham); group 2, sciatic nerve crush injury (control); group 3, sciatic nerve crush injury+genistein 20 mg/kg; group 4, sciatic nerve crush injury+gabapentin 90 mg/kg; group 5, sciatic nerve transection+genistein 20 mg/kg; group 6, sciatic nerve transection+gabapentin 90 mg/kg. The effects of genistein and gabapentin were assessed with immunohistochemical staining for growth associated protein-43 (GAP-43) and myelin basic protein (MBP). Interleukin-1ß and tumor necrosis factor α levels in the injured nerve specimens were assessed as a measure of inflammatory response; walking track analysis and sciatic function index for neurological recovery and the paw mechanical withdrawal threshold were examined for neuropathic pain. RESULTS: On histopathological examination, genistein use was associated with a greater immunoreactivity for GAP-43 and MBP compared with that associated with gabapentin. Genistein and gabapentin had similar effects on anti-inflammatory activity, functional recovery, and neuropathic pain. CONCLUSION: Genistein and gabapentin exhibit positive effects on histopathology, inflammation, and clinical findings of peripheral nerve injury. When the systemic side effects of gabapentin are considered, genistein (a basic soy isoflavone that has no side effects) can be used as an alternative to medical treatment in peripheral nerve injury.

Implant Migration in Cervical Disk Arthroplasty.

OBJECTIVE: The purpose of this study is to discuss the causes of implant migration after cervical arthroplasty with clinical cases. METHODS: The patients who underwent cervical arthroplasty operations in our department between 2006 and 2015 because of cervical disk disease were retrospectively analyzed. The patients who were determined to be symptomatic of implant migration were evaluated. RESULTS: Symptomatic implant migration was detected in 5 of 163 (0.3%) patients who underwent cervical disk arthroplasty, and these patients also underwent reoperation. In 4 patients who underwent reoperation, the prosthesis was removed, and an anterior fusion was made. The prosthesis was only removed in 1 patient. CONCLUSIONS: The following situations should be considered in the prevention of dislocation and migration of the implant in cervical arthroplasty: protection of the structure of the end plate, selection of the appropriate implant size, and proper surgical construction. In the preoperative period, computed tomography scan may be useful for determining the implant size and details of the bone structure. Foreign body reactions or postoperative trauma may be a rare and unpreventable reason for prosthesis dislocation despite all of the preoperative and perioperative measures and well-made prosthesis designs.

Histopathological Evaluation of the Effects of CAPE in Experimental Spinal Cord Injury.

AIM: < /B > Spinal cord injuries negatively affect the individuals and the life quality of their families due to neurological deficits caused by trauma. The prevalence of spinal cord injury is 15-45/1 million in the world. Caffeic acid phenethyl ester (CAPE) is the most active component of propolis and has neuroprotective, anti-oxidant and anti-apoptotic effects. Our aim was to determine the effects of CAPE on the prevention of secondary injury and to compare with methylprednisolone. MATERIAL AND METHODS: Forty rats were divided into 4 groups. The control group did not undergo surgery (Group I), only trauma group (Group II), trauma+CAPE treatment group (Group III), and trauma+methylprednisolone treatment group (Group IV). Histopathological assessment was performed with two staining methods as hematoxylin-eosin (HE) and terminal deoxynucleotidyl Transferase Biotin - dUTP Nick End Labeling (TUNEL). The groups were statistically compared. RESULTS: The apoptotic cells decreased in treatment groups compared with the trauma. CAPE has more anti-apoptotic effect than methylprednisolone. The histological difference between the Group II, and Groups III and IV was statistically significant. CONCLUSION: CAPE has a positive effect on spinal cord injuries by preventing apoptosis.

True aneurysm of superficial temporal artery accompanying multiple intracranial aneurysm.

Superficial temporal artery (STA) aneurysms are very infrequent. Moreover, true aneurysms, which are not pseudoaneurysms associated with trauma or previous surgery are even rarer. With this manuscript, authors present a case of a 79-year-old woman suffering from subarachnoid hemorrhage whose radiological examinations revealed multiple intracranial aneurysms along with an STA aneurysm. This very rare case, to the best of our knowledge, the second case reported so far, might contribute to the literature and lead further investigations toward the rare association between intracranial aneurysms and STA aneurysms.

Effectiveness of physical therapy and rehabilitation programs starting immediately after lumbar disc surgery.

AIM: The aim of this randomized study was to compare exercise program to control group regarding pain, back disability, behavioural outcomes, global health measures and back mobility who underwent microdiscectomy operation. MATERIAL AND METHODS: Thirty patients who underwent lumbar microdiscectomy were randomized into exercise and control groups. After surgery, patients in the exercise group undertook a 12-week home based exercise program, started immediately postsurgery and concentrated on improving strength and endurance of the back, abdominal muscles, lower extremities and mobility of the spine and hips. Outcome measures were: Oswestry Disability Index (ODI), Beck Depression scale, lumbar schober, Visual Analogue Scale (VAS), return to work (return-to-work status), generic functional status (SF-36). RESULTS: Treatment compliance was high in both groups. Surgery improved pain, disability, general health status, lumbar mobility and behavioural status. After the exercise program, the exercise group showed further improvements in these measures at 12 week after surgery. CONCLUSION: A 12-week postoperative exercise program starting immediately after surgery can improve pain, disability, and spinal function in patients who have undergone microdiscectomy.

A late and extreme complication of lumboperitoneal shunt.

BACKGROUND CONTEXT: Lumboperitoneal (LP) shunting is an effective treatment modality for commmunicating hydrocephalus, pseudotumor cerebri, postoperative pseudomeningoceles, and cerebrospinal fluid fistulas. However, LP shunts are associated with some complications. Here, we report an extreme complication resulting in the formation of granulation tissue. PURPOSE: To report a late extreme complication of LP shunt. STUDY DESIGN: A case report. METHODS: A late and unusual complication of an LP shunt with unique radiologic findings is presented. RESULTS: Spinal magnetic resonance imaging studies depicted a mass on the right anterior section of the dural sac encircling the catheter throughout its course from the L3-L4 interspinous level to the catheter tip. CONCLUSIONS: The etiopathologic mechanism, the prolonged duration, and the unusual radiologic findings in this case are unique and remarkable.

Efficacy of prognostic factors on survival in patients with low grade glioma.

AIM: In this report, we aim to determine the prognostic factors influencing the length of survival in patients with low-grade gliomas. MATERIAL AND METHODS: In a retrospective evaluation, we have reviewed fiftythree patients who had been operated between the years of 1980 and 2006. The diagnoses of the patients were histopathologically verified as low-grade glioma(LGG). The medical records of the patients were reviewed for age, gender, tumor locations, extent of resection, and presence of seizure, the neurological status as defined by the Karnofsky Performance Scale (KPS) and radiotherapy treatment after surgery as possible prognostic factors. RESULTS: Median cumulative survival time for all the patients with LGG was 141+/-14.83 months. Median survival time was 216+/-78.52 months for astrocytoma Grade I; 115+/-8.22 months for astrocytoma Grade II, and 242+/-76.36 months for oligodendroglioma. Young age, histology subtype (oligodendroglioma) and preoperative KPS were determined to have positive influence on survival according to Log Rank Test. In contrast, age, histology type and the extent of resection remained independent prognostic factors upon survival when Cox Regression Backward Stepwise (Wald) method was performed. CONCLUSION: It can be concluded that surgery seems to be an appropriate first step option in the treatment of LGG.

Nitric oxide level and adenosine deaminase activity in cerebrospinal fluid of patients with subarachnoid hemorrhage.

OBJECTIVE: Adenosine and nitric oxide (NO) are known as vasodilatators. We investigated adenosine deaminase (ADA) activity and NO concentration in the cerebrospinal fluid (CSF) of patients with subarachnoid hemorrhage (SAH). METHODS: Forty patients with SAH and 10 controls were included in the study. Nitrate level and ADA activity were measured in CSF. SAH patients were grouped according to the presence of angiographic vasospasm, Hunt and Hess grading, Glasgow Coma Scale (GCS) and Fisher Grade (FG). RESULTS: The level of NO markers in SAH patients decreased when compared to that in the control group (p < 0.05). However, NO markers in patients with vasospasm was higher than in that of patients without vasospasm (p < 0.05). ADA activity increased in patients with SAH (p < 0.01) and also patients with angiographic vasospasm (p < 0.05). ADA activity in the poor-grade SAH group was higher than that in the good-grade SAH group. The group with the lower GCS showed increased ADA activity compared to those with a higher GCS score (p < 0.01). Furthermore, patients with FG 4 had a higher level of ADA activity compared to FG 1 and 2 and FG 3 (p < 0.001 and p < 0.01, respectively). CONCLUSION: Decreased NO level may participate in the early development of vasospasm. However, the increased level of ADA activity in the SAH patients with the poor clinical and consciousness level may have resulted from the ischemic cerebral insult.